A Multicenter Study of ICU Telemedicine Reengineering of Adult Critical Care
A Multicenter Study of ICU Telemedicine Reengineering of Adult Critical Care
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DOI：
10.1378/chest.13-1973
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发表时间：
2014-03-01
期刊：
影响因子：
9.6
通讯作者：
Irwin, Richard S.
中科院分区：
文献类型：
--
作者：
Lilly, Craig M.;McLaughlin, John M.;Irwin, Richard S.
背景：很少有研究评估了ICU远程医疗项目的总体效果和干预的个别组成部分对临床结果的影响。方法：观察非随机ICU远程医疗干预对粗死亡率、调整死亡率和住院时间（LOS）的影响。此外，还评估了与护理过程和环境相关的个体干预成分与死亡率和LOS的关系。结果：总体而言，纳入了来自美国19个卫生保健系统32家医院56个icu的118,990名成年患者（11,558名对照组，107,432名干预组患者）。经统计调整后，住院（风险比[HR] = 0.84, 95% CI为0.78 ~ 0.89,P = 14, >= 30天）。干预措施的个别组成部分与较低的死亡率、较低的LOS或两者都相关，包括(1)入院后1小时内重症监护医生对病例进行复查，(2)及时使用性能数据，(3)遵守ICU最佳实践，(4)更快的警报响应时间。结论：ICU远程医疗干预，特别是增加重症监护患者早期病例参与、提高对ICU最佳实践的依从性、缩短对警报的响应时间和鼓励使用绩效数据的干预措施，与降低死亡率和LOS相关。
Background: Few studies have evaluated both the overall effect of ICU telemedicine programs and the effect of individual components of the intervention on clinical outcomes.Methods: The effects of nonrandomized ICU telemedicine interventions on crude and adjusted mortality and length of stay (LOS) were measured. Additionally, individual intervention components related to process and setting of care were evaluated for their association with mortality and LOS.Results: Overall, 118,990 adult patients (11,558 control subjects, 107,432 intervention group patients) from 56 ICUs in 32 hospitals from 19 US health-care systems were included. After statistical adjustment, hospital (hazard ratio [HR] = 0.84; 95% CI, 0.78-0.89; P = 14, and >= 30 days, respectively. Individual components of the interventions that were associated with lower mortality, reduced LOS, or both included ( 1) intensivist case review within 1 h of admission, ( 2) timely use of performance data, ( 3) adherence to ICU best practices, and ( 4) quicker alert response times.Conclusions: ICU telemedicine interventions, specifically interventions that increase early intensivist case involvement, improve adherence to ICU best practices, reduce response times to alarms, and encourage the use of performance data, were associated with lower mortality and LOS.